Multiple Sclerosis

Multiple sclerosis (MS) is a disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. It impacts the brain and spinal cord which make up the central nervous system and controls everything we do. 

It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild. In many cases, it’s possible to treat symptoms. 

In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.

Signs / Symptoms

What's common signs of Multiple Sclerosis?

Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance. Depending on the type of MS you have, your symptoms may come and go in phases or get steadily worse over time (progress).

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers.

 

Symptoms often affect movement, such as:

  • Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk
  • Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
  • Tremor, lack of coordination or unsteady gait

Vision problems are also common, including:

  • Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
  • Prolonged double vision
  • Blurry vision

Multiple sclerosis symptoms may also include:

  • Slurred speech
  • Fatigue
  • Dizziness
  • Tingling or pain in parts of your body
  • Problems with sexual, bowel and bladder function

Common causes

What's common causes of Multiple Sclerosis?

The cause of multiple sclerosis is unknown. It’s considered an autoimmune disease in which the body’s immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys the fatty substance that coats and protects nerve fibers in the brain and spinal cord (myelin). It isn’t clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible.

Departments & Emergency

See a GP if you’re worried you might have signs of MS. The symptoms often have many other causes, so they’re not necessarily a sign of MS. If they think you could have MS, you’ll be referred to a specialist in conditions of the nervous system (a neurologist), who may suggest tests such as an MRI scan to check for features of MS.

Diagnosis

There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Your doctor is likely to start with a thorough medical history and examination and then may recommend;

  • Blood Tests
  • Lumbar Puncture( spinal tap)
  • MRI
  • Evoked Potential Tests

In most people with relapsing-remitting MS, the diagnosis is fairly straightforward and based on a pattern of symptoms consistent with the disease and confirmed by brain imaging scans, such as MRI.

Diagnosing MS can be more difficult in people with unusual symptoms or progressive disease. In these cases, further testing with spinal fluid analysis, evoked potentials and additional imaging may be needed

Treatment

There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary. At the moment treatments are administered according to need such as;

  • Treatments for MS attacks
  • Treatments to modify progression
  • Treatments for MS signs and symptoms:
    • Physical Therapy
    • Muscle Relaxants
    • Medication to reduce fatigue
    • Medications to increase speed
    • And other medications
  • Lifestyle and Home Remedies:
    • Rest
    • Exercise
    • Balanced diet
    • Cooling down
    • Mental health regulation
  •  

Much of the immune response associated with MS occurs in the early stages of the disease. Aggressive treatment with these medications as early as possible can lower the relapse rate, slow the formation of new lesions, and potentially reduce risk of brain atrophy and disability accumulation.

Drugs for Multiple Sclerosis

There are many types of drugs to use for multiple different aspects of MS. We can summarize them as:

  • Drugs for MS attacks:

– Corticosteroids

– Plasma exchange (plasmapheresis)

  • Drugs to modify progression:

– Interferon beta medications. (injection)

– Glatiramer acetate (Copaxone, Glatopa). (injection)

– Fingolimod (Gilenya). (oral)

– Dimethyl fumarate (Tecfidera). (oral)

– Ocrelizumab (Ocrevus). (Infusion)

– Natalizumab (Tysabri). (Infusion)

  • Drugs to reduce fatigue
  • Drugs to increase speed

Surgery

MS has no cure. However, treatments can help make symptoms less severe and improve quality of life. Surgical treatments for MS are available. Most of them are designed to provide specific symptom relief.

  • Deep Brain Stimulation
  • Opening Blood Flow
  • Intrathecal baclofen pump therapy
  • Rhizotomy

 

FAQs

What are the types of MS?

While there is no way to predict with any certainty how MS will progress, four basic disease courses have been defined:

  • Clinically isolated syndrome-first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system.
  • Relapsing-remitting MS -characterized by periods of relapses (new symptoms or a new worsening of older symptoms also called attacks or exacerbations) that subside, with full or partial recovery, and no disease progression (worsening) between attacks.
  • Secondary progressive MS- follows relapsing-remitting MS in some people and is characterized by a more progressive course, with or without relapses or new MRI activity.
  • Primary progressive MS is characterized by a gradual but steady progression of disability from the onset of symptoms, with few or no relapses or remissions.

 

Is MS fatal?

Research indicates that the average life expectancy of people with MS is about seven years less than the general population because of disease complications or other medical conditions. Many of these complications are preventable or manageable. Attention to overall health and wellness can help reduce the risk of other medical conditions, such as heart disease and stroke, that can contribute to a shortened life expectancy. In very rare instances, MS can progress rapidly from disease onset and can be fatal.

 

Does MS always cause paralysis?

No. Moreover, the majority of people with MS do not become severely disabled. Two-thirds of people who have MS remain able to walk, though many will need an aid, such as a cane or crutches, and some will use a scooter or wheelchair because of fatigue, weakness, balance problems, or to assist with conserving energy. 

 

Can MS be cured?

Not yet. There are now FDA-approved medications that have been shown to “modify” the course of MS by limiting new areas of damage in the CNS, reducing the number of relapses and delaying progression of disability. In addition, many therapeutic and technological advances are helping with more effective symptom management. Advances in treating and understanding MS are made every year, hopefully moving research closer to identifying a cure.

 

Is MS contagious or inherited?

No. MS is not contagious or directly inherited. Studies do indicate that genetic factors and certain environmental factors may make certain individuals more susceptible to the disease.

References

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